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Michael Sultan warns of the dangers of pseudoscience.
I
2007
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14 The Dentist March 2014
was disappointed to read a number
of articles that claimed 97 per
cent of terminal cancer patients
have had root canal treatment in the
past. This upset me on a number of
different levels, not only because of the
implied causal link between root canal
treatment and cancer, but also the
fact that this alarmist nonsense can be
pedalled out so convincingly by and to
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Reader Enquiry 11
Ring the alarm
Michael Sultan
is a specialist in endodontics and
clinical director of EndoCare.
16/01/13 13:26
apparently intelligent people.
It is worrying that in the 21st
century there are still people out there
regurgitating the work of Dr Weston
Price and his ilk. Even more concerning
is the thought that articles such as
these may well be putting patients
off root canal treatment based on this
misguided ‘science’.
An awful lot of the pseudoscience
that can be found on endodontics
can be linked back to Focal Infection
Theory (FIT) that was popular for the
early part of the last century. According
to the theory a localised infection will
disseminate micro-organisms or their
products to a distant site in the body.
As a result of focal infection theory
conservative dental treatment was
avoided for many years and extraction
was recommended instead.
This continued right up until the
1950s when advances in endodontics
The dental conspiracy
Pseudoscience seems to be everywhere
these days. The internet has certainly
given the pseudoscientists a new
platform to reach out and share scare
stories for their own financial gain. It
astounds me that they act as if there’s
some major conspiracy going on; that
doctors and dentists are somehow
working to hide the fact that they are
secretly poisoning patients – for what
reason I couldn’t begin to imagine.
In the past it was silver amalgam
fillings that were part of the conspiracy,
but now it seems to be endodontics.
While we endodontists are apparently
the villains, the heroes are those nice
‘biological’ dentists - you know, the
ones who really understand and care
for their patients. Influenced by the
‘visionary’ Hal Huggins, biological
dentists are concerned with how
dentistry affects the entire body. Of
course our biological friends are
aware that root canals are difficult,
and that we can never absolutely
sterilise a canal. But then they take
this argument further and claim
that pockets of bacteria that are left
untreated are leaching out, causing
organs to fail. That is why biological
dentists recommend extraction, plus
removal of the periodontal ligament
and the surrounding area of dead bone.
Personally I think I would prefer a root
canal.
Teeth as causative agents
The problem with our friends is that
they have a great ability to take a
grain of truth and extrapolate it and
draw conclusions that the science
just doesn’t suggest, but with quite a
seductive and reasonable-sounding
tone. They are of course quite right
that bacteria from oral sources can
enter the bloodstream (though let’s
not forget bacteraemias also occur
naturally through normal everyday
processes such as chewing and even
brushing our teeth). They are also
quite correct that bacteria can enter
the bloodstream due to endodontic
sources such as acute dental abscesses
and instrumentation during canal
preparation. Furthermore, they are also
correct that it is virtually impossible to
full clean out a root canal system and
that some bacteria will inevitably be
left behind. So far so good, however
there is no evidence that these bacteria
are constantly leaking out of the tooth
causing bacteraemias. And even if
they were we would need a number of
factors to combine to cause a problem:
we would need a large number of
viable bacteria that can survive host
responses; these bacteria would
then have to encounter predisposing
conditions for attachment, reach
sufficient numbers for disease, and
have virulence to actually cause
disease. There is so far zero evidence
for this.
Trust in science
If pseudoscience teaches us anything,
it is that it is very easy to be selective
or deliberately misleading with facts.
While pseudoscience may not bring
about the death of endodontics per se,
it is still certainly influencing a great
many people into making decisions
based on hearsay and outdated
‘science’ that has no grounding in the
modern day world.
As dentists we are fully aware of just
how intricate and difficult to prepare
a root canal system can be. However
with the latest equipment, irrigants and
three-dimensional filling we can really
cut down on the number of bacteria in
a tooth and entomb any survivors so
that they wither and die. We are also
aware of the need of a coronal seal to
prevent further ingress of bacteria and
know that the inflamed teeth that we
treat never had an infected root canal
system to start off with.
If pseudoscientists had their way I
am sure we would return to the 1920s
and extract every single infected
tooth, but thankfully we’ve moved on
since then. With the latest advances
in endodontics, root canal treatments
are safer and more successful than
ever before, and an option we can
offer patients with complete clinical
confidence.
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coupled with advances in biology and
epidemiology start to bring about the
theory’s demise. However, this is not
to say that FIT has completely gone
away. Despite a lack of real scientific
evidence, FIT and similar theories are
still very much with us, and are being
used to undermine scientifically sound
treatments that save teeth and improve
patients’ quality of life.
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Reader Enquiry 12
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15 The Dentist March 2014